Complete Defiance and tantrums with ADHD

[daemaitehn]

Hello Everyone,

I have some questions/need some advice. My daughter is 7, diagnosed with ADHD, is taking Focalin XR and has started back at school for second grade. For the last 3 years, we have been through a journey with school and at home, and things are not seeming to get better.

We took her to a phsycologist and she was diagnosed with ADHD after the 3-4 hour series of tests they did. They also did a questionaire with parents and teachers and concluded with her diagnosis.

In first grade, we decided to try medication since we started to realize/notice that things where effecting her relationship with us (her parents) and with her friends. I did notice that the medication would help her focus, but did not seem to really help with her defiance and complete lack of listening. Her tantrums/outburst where still present. One day at school she cleared off a shelf of books/games/puzzles, I was called into school. By time I arrived, she was calm and cleaning the mess.

Fast forward to this year, second grade, and I have been called in, yesterday, since she was defiant with the teacher. She was putting marker and hand sanitize on her lips and face, moving her behavior marker to green (instead of red), took something from teachers desk, etc. The teacher used all her tools as we requested, then called the principle who had to physically remove her from the classroom (not the first time).

When I am called into school, I have the same conversations, constantly feeling like the principle thinks I have no idea what I am talking about, like her behavior has nothing to do with ADHD and that I am doing something wrong. Maybe I am doing something wrong, maybe her behavior is not related to ADHD, I am no expert.

At home we observe screaming, shouting, hitting, disrespect towards us, her brother, and the home itself. Pounding on doors, slamming doors, hitting the table with forks/spoons. Over all, physical damage has been done to the house. Things have gotten to the point which we send her outside and lock the door since we are afraid we will explode with her. Unfortunately, I have exploded with her and yelled, held her down, etc. The outburst from my end are not the correct approach.

We are trying a new positive reinforcement chart at home which only rewards with screen time, which she likes. When she missed a opportunity to receive a check, we remind her that she missed an opportunity. We do not take away or punish since that does not seem to work.

I am wondering if medication should be adjusted, if I should take a different approach? I am really tossing in my white flag here, have been at that point for a while now. Are there any good articles around medication and when to adjust dosage/change?

Thanks everyone!

[Onthemove1971]

Daemaitehn...wow first of all big hugs to you and your family for traveling this journey. I can say it will get better hang in there. YES, in my "mom" opinion, if your childs medication is not being managed by a child psychiatrist please run to one now. A child who is taking proper medication should not be acting like this. We were told by our child psychiatrist %60 can be controlled by medication and %40 should be controlled by behavior modification.

You are doing so many thing right, just believe it will get better. Also are you taking her to a counselor to talk about each of these issues, so you can get their take in things?

If you can find what triggers her and avoid them, that might help.

Best of luck and I hope in changing her medication with the proper Specialist things will improvd for you and your family.

[daemaitehn in reply to Onthemove1971]

That is another issue. She does not want to talk about these issues with anyone. Not the teacher, the principle, me, my wife, the psychologist. No one. I would like to talk about them and try to figure things out. Sometimes she will respond, but usually she just shuts down or has such an attitude, it is a pointless discussion.

For medication, the psychologist does not prescribe, but has given us some advice around the medication. For her actual prescription, she sees a family dr. That was good for me, since I had a hurdle with the idea of medication, and I feel comfortable with him.

[Onthemove1971 in reply to daemaitehn]

Darmaiehn- You came on to this group for suggestions. We spend many years on the wrong medication, thinking "oh yeah, we can get by like this, becuase my life is super busy"

My child was on a single dose of medication and managed by his family doctor, then things got unmanageable and we hit middle school, the worse year of our lives. I really didn't want another Specialist in our lives. Once we found a child psychiatrist who really studied our child and we went through some different trials of medication our live has become almost normal. It is my believe when someone has a child with complex behavior needs they need to see the Specialist to help them. Medication is the answer for us and we also see a counselor who trains me/us and my son on how to deal with many issues.

Best of luck with your child.

[Madmarie in reply to daemaitehn]

I was having some similar incidents with my son. I just explained my frustrations w/ his Dr. He increased his dose and added intuitive to his medication. I have to say things are so much better! He is a lot less angry, and confrontational. I chopped his behavior up to his ADHD. Please just talk to her Dr.

[Pennywink]

Wow - sorry to hear that! Like Onthemove1971 said, a medication adjustment from a pediatric psychiatrist who specializing in ADHD is definitely something to look into.

You might want to also research parenting strategies for Oppositional Defiance Disorder. (Not that I'm diagnosing your child, but the strategies are pretty compatible with kids with ADHD, and probably any parenting. ODD is pretty common in kids with ADHD, though it is usually helped a lot by ADHD medication.)

The positive reinforcement chart sounds like a great step - I know praise is much more effective with my son than punishment. He really needs that adult connection to WANT to behave, or at least try. Also making adjustments for his ADHD (analog clocks & timers, checklists, dry erase boards with reminders) has helped him not get so frustrated, which has helped him control his behavior.

[daemaitehn in reply to Pennywink]

I have read into ODD and guess I need to further research.

[daemaitehn]

Does this behavior sound common or alarming. I am still trying to gauge my situation.

[Pennywink in reply to daemaitehn]

The behavior is more extreme than what I've experienced, but each child is different. Maybe someone with a more similar experience will have better advice for you.

I'm definitely not trying to freak you out and say that she has ODD - just that the parenting strategies for ODD seem to me to be helpful for all ADHD children and worth looking into. There's even disagreement if ODD is a thing, if it's a diagnosable thing, if it's just the emotional / social aspect of ADHD, etc.

Here's an article that may shed some light. All three doctors mentioned (Greene, Dobson and Barkley) are all ADHD specialists whom I've found valuable information from, and I highly encourage looking up more of their works.

additudemag.com/adhd-odd-wh...

[daemaitehn in reply to Pennywink]

Thanks. This is not the first time I have heard of ODD. The principle actually suggested this. I am not precisely sure why I did not act on this, I think I was more focused on my personal life issues I was dealing with.

I will bring this up with the physiologist.

[MaudQ]

When you did the psych evaluation, did they say she only had ADHD? My kid also has anxiety which is very common to have with ADD - I think a lot of kids have more than one issue. I ask, because my 10 yo daughter also has outbursts and temper tantrums that often include extremely defiant and sometimes strange behavior and I’m just starting to understand how much of a role anxiety plays in this. My daughter also didn’t want to talk to anyone but now that she’s been in therapy for a while has gotten much much better at talking about her feelings. We are also looking into OT in addition to therapy and medication because there seems to be a sensory thing going on too -

I’m thinking of your story about the marker and hand sanitizer. My kid is really into messy, mushy stuff and makes huge messes ... I’m really sorry you’re having such a hard time. Hope this helps.

[daemaitehn in reply to MaudQ]

For now, we only have a ADHD diagnosis. I have been wondering if there is more too it, just so we can rebuild and move forward. Tired of feeling like this is destroying our family.

I will mention if there are other things occurring to the psychologist. Thank!

[anirush]

This sounds like my 12 year old grandson when he was younger, long tantrums destroying stuff in school. He is on three different medications Strattera for ADHD, risperidone for the anger, and generic Trileptal for mood swings. We also are seeing a behavioral counselor because like others said everything can't be controlled by medication.

I got so tired of being told by school principal that he could control this. You get to where you want to avoid calls from the school.

I'm sure my grandson has ADHD, ODD, and his psychiatrist had said possibly bipolar disorder. Definitely talk to your psychiatrist, this behavior is way out of control.

[Kiandra]

Hun, she needs an after noon pill. You can do 5mg adderall. Or 10mg give it to her between 12-1pm if she takes her meds between 6-8am. My kid is on the same morning med. But she needs an afternoon med. Homework is very difficult to try to get her to focus if she don't take her afternoon meds

[Deesol]

Sounds like we are in the same boat. My daughter, 7, second grade, is pretty much how you described your daughter. We have not been called into school but all the behaviors are similar. We had our daughter on Adderall xr and then focalin. Both medications brought out the worst. We are now having her take Dexedrine and Tenex and are playing around with the dosage of those together to see if we can find a good balance. We should chat sometime.

[Mudpies]

So sorry!!! We went through this and we found that stimulant medication (he happened to be taking Focalin xr too) was exacerbating his anger and defiance issues. We switched to a non-stimulant and my kind little boy is back who wants to try harder and apologizes when he makes a mistake. I am not saying this is what’s going on with your child but I highly suggest speaking with your child’s psychiatrist about it and letting them know what’s going on. We started with our pediatrician too but as soon as we realized we were out of the ordinary bounds of stimulants he referred us. I honestly thought that his attitude was just part of the ADHD or possibly even ODD but 4 days after coming off of stimulants he was a different child in that regard. Wishing you the best!!

[daemaitehn]

Thanks everyone. We did try a day without the medication, which my understanding was this would have shown if the medication was the cause. She seemed to have an even harder time controlling herself. I cannot recall if her personality was better or not. Also, this is not a consistent occurrence. It seems to be more random. For example, she had a great day at school, then at night we went to swim and she behaved very well, the entire time. I knew she was having a hard time focusing since it was the end of the day and her medication had worn off/started to wear off.

Does this sound accurate? Or would the medication cause the same behavior, every day?

[Madmarie]

I’m having the same issue with my 10yr. Old son. He’s been suspended already this year. He just started 4th. grade. It’s been tough. He also has epic meltdowns, and can be very destructive inside my home. To make matters worse, my ex. just wants to blame everything on me, and tells me he doesn’t have those issues at his house. (Complete B.S. ) His idea of disciplining my son is to Yell, tear him down, and at times has gotten physical. I’ve tried to create a peaceful life for me, and my son after the divorce 4yrs. ago. I live in a cul-de-sac. I have a cute little house, right around the corner from his school. He’s gotten in trouble at school. I work closely with the Principal, and teachers. Emails/ texts even sitting in the classroom from time to time. His dad is now saying he’s not meant go to public school, and wants to do a homeschool or some type of charter school. (He moved 35min from his school) so I feel this has a lot to do with it. It’s just not a option for me, or my son. I travel for my job, and live 3-blocks from my sister, and her family. They help me out, and provide the support I need. I feel the best thing to do is keep him at his school. He genuinely loves it. He just is having issues with aggression, when he gets upset, either with another student, or school work. I’m working with his Dr. to find a new balance of medication. Which also makes me nervous. His dad says I’m drugging him. He said the answer is not drugs! We start behavioral therapy next week. I’m hoping and praying for resolve! I’ve become so anxiety ridden, every time the phone rings during the day, thinking it’s the school. I’m in therapy, and started medication my self. It seems to be helping a bit. 🙏

[daemaitehn]

Just wanted to post a follow up for everyone. We made a medication adjustment to her Focalin Xr and noticed a difference the very first day. We then went to see our Psychologist, who was not happy with the school. We also saw a child Psychiatrist, who stated we could add guanficine to assist with the combativeness of her outbursts, but if the Focalin XR is working, we should not adjust at this time.

General feedback from the school was that things where improving, until we made some suggestions which we felt could help. We are now receiving more and more messages that my child's behaviors are 'intentional' and not part of her ADHD diagnosis. The very difficult part is they seem to be unaware of how ADHD can affect a child and the outcome of certain situations when they have ADHD.

We have discussed various situations with our psychologist, and provided specific events which the teacher wrote down with her. Her direct response was that her behavior was ADHD. Me and my wife have advocated for our daughter, and we are just talking in circles with the school. There is complete rejection of what we tell them, which we have learned from research and from our psychologist. We have a meeting set up with the school to determine a 504 plan/behavior plan and are trying to bring an Educational Consultant to further advocate for our daughter which was suggested from our psychologist.

I do not know the end result yet, but we are trying and advocating for her. A school change might be required, which is unfortunate, but we are started to hit a wall.